Spironolactone

Spironolactone has weak progestogenic activity because it a small potential to be an agonist at certain progesterone receptors (approximately 1/10 of its potency at androgen receptors). The progestogenic activity is assumed to be what causes menstrual irregularities in some people.

Spiro also has weak estrogenic effects because

• Androgens suppress estrogen production and activity. When you reduce androgens, you give estrogens more power.
• Displacing estrogen from SHBG. Spiro blocks more estrogens from SHBG than androgens, which means more free estrogens than free androgens.
• Weakly inhibits estradiol (one type of estrogen) from converting to estrone (another type of estrogen). Matters because estradiol is more potent than estrone.
• Enhances the rate at which testosterone converts to estradiol.

Metformin

Decreases serum testosterone in this study and in this study.

The key rationale for metformin in infertile women with PCOS is the presence of a positive correlation between the degree of insulin resistance and anovulatory infertility in these women (3) . Although the mechanisms linking insulin resistance with anovulatory infertility in PCOS are debatable, proposed mechanisms include a direct stimulation of androgen production from the ovarian stromal cells ( which is thought to directly impair follicle development), impairment of local steroidogenesis mediated via an imbalance in the production of insulin like growth factors and a direct stimulatory effect on a local (intra-ovarian) protease inhibitor, plasminogen activator inhibitor-one (PAI-1) limiting follicle growth (4). It is thought that Metfomin by suppressing hepatic gluconeogenesis and improving peripheral insulin resistance reduces ovarian hyperandrogenaemia, and restores normal ovarian steroidogenesis and PAI-1 levels thus enhancing ovulation and improving fertility. Metformin has also been shown to reduce systemic luteinising hormone (LH) and PAI-1 levels, both of which have been associated with an increased risk of miscarriage.

Thank you for this information. To your knowledge or in your opinion, would it be beneficial (in balancing my hormones/improving my acne) to use spiro, metformin and progesterone cream? If so, could you explain to me how they work together? The spiro alone doesn't seem to be working for me anymore. I just got two more nodules in as many days.

I really appreciate the opportunity to tap into your abundant knowledge about hormonal treatments!!!

Spironolactone

Spironolactone has weak progestogenic activity because it a small potential to be an agonist at certain progesterone receptors (approximately 1/10 of its potency at androgen receptors). The progestogenic activity is assumed to be what causes menstrual irregularities in some people.

Spiro also has weak estrogenic effects because

 

• Androgens suppress estrogen production and activity. When you reduce androgens, you give estrogens more power.
• Displacing estrogen from SHBG. Spiro blocks more estrogens from SHBG than androgens, which means more free estrogens than free androgens.
• Weakly inhibits estradiol (one type of estrogen) from converting to estrone (another type of estrogen). Matters because estradiol is more potent than estrone.
• Enhances the rate at which testosterone converts to estradiol.

Metformin

Decreases serum testosterone in this study and in this study.

The key rationale for metformin in infertile women with PCOS is the presence of a positive correlation between the degree of insulin resistance and anovulatory infertility in these women (3) . Although the mechanisms linking insulin resistance with anovulatory infertility in PCOS are debatable, proposed mechanisms include a direct stimulation of androgen production from the ovarian stromal cells ( which is thought to directly impair follicle development), impairment of local steroidogenesis mediated via an imbalance in the production of insulin like growth factors and a direct stimulatory effect on a local (intra-ovarian) protease inhibitor, plasminogen activator inhibitor-one (PAI-1) limiting follicle growth (4). It is thought that Metfomin by suppressing hepatic gluconeogenesis and improving peripheral insulin resistance reduces ovarian hyperandrogenaemia, and restores normal ovarian steroidogenesis and PAI-1 levels thus enhancing ovulation and improving fertility. Metformin has also been shown to reduce systemic luteinising hormone (LH) and PAI-1 levels, both of which have been associated with an increased risk of miscarriage.

Mainly Metformin seems to affect the pituitary hormones (LH and FSH).